GC | Overview

Overview | Glycemic Control Implementation Toolkit

This implementation toolkit is designed to enhance the efficiency and reliability of your quality improvement efforts. The elements are based on well-proven principles of quality improvement, personal experiences, and evidence-based medicine. Using the methods, tools, and information provided in the implementation toolkit will help you close the gap between known best practices and common, often sub-optimal, methods for caring for the inpatient with hyperglycemia.

Learn how “sweet” SHM's Glucometrics Reports are and how to benchmark your hospital against other Glycemic Control Program participants. Track your performance through the Electronic Quality Improvement Program (eQUIPS) or join the Glycemic Control Mentored Implementation Program, which leads institutions through the process of implementing the principles outlined in this toolkit. SHM is now accepting applications to the Fall 2014 GCMI Program.

The Glycemic Control Implementation Toolkit will enable you to implement effective regimens and protocols that optimize glycemic control and minimize hypoglycemia in your institution by providing you with information on:

How to Use:

The Glycemic Control (GC) Implementation Toolkit is the online version of the Glycemic Control Implementation Guide and addresses in detail the essential elements for reaching breakthrough levels of improvement in the care of hyperglycemic inpatient. Review the How to Use portion of the toolkit for guidance and an introduction to the information you will find in the implementation toolkit whether you are just beginning a quality improvement (QI) initiative or have made considerable progress.

Implementation Guide/Supplement:

Download and print the Glycemic Control Implementation Guide/Supplement entitled, Workbook for Improvement: Improving Glycemic Control, Preventing Hypoglycemia, and Optimizing Care of the Inpatient with Hyperglycemia and Diabetes, which serves as the portable version of the Glycemic Control Implementation Toolkit.

First Steps:

Set up your team for success. Move ahead only with the support of your institution and an understanding of your environment. Know where you are going and how you will get there by setting goals and using a framework for improvement.

  1. Ensure support from the institution.
  2. Survey previous or ongoing efforts and resources.
  3. Clarify key stakeholders, reporting hierarchy, and approval process.
  4. Assemble an effective team.
  5. Set general goals and a timeline.
  6. Follow a framework for improvement.

Best Practices:

Review what the literature says about inpatient glycemic control. Package that knowledge into a protocol that is aligned with the scope of your project.

  1. Know what the literature says about patients’ risk for hyperglycemia and hypoglycemia.
  2. Know what the literature says about options for addressing inpatient glycemic control across the care continuum.

Analyze Care Delivery:

Diagram your current care delivery. Understand its inter-related steps and failure modes. View care delivery as a series of intermediate steps leading to the clinical endpoint of interest. Recognize which steps should become metrics for glycemic control, safety (including hypoglycemia), and insulin use patterns.

  1. Qualitative analysis: diagram care delivery to identify failure modes.
  2. Quantitative analysis: analyze care.

Track Performance:

Select key metrics. Collect the data needed to track performance on these metrics. Plot and report data on a run chart. Write the aim statement that will be your benchmark for success. Consider tracking balancing measures.

  1. Key metric #1: Glycemic Control (GC).
  2. Key metric #2: Safety (Hypoglycemia and Extreme Hyperglycemia).
  3. Key metric #3: Insulin use patterns and others.
  4. Data collection.
  5. Data reporting using run charts.
  6. Transform general goals into a metric-specific aim statement.

Reliable Interventions:

Start with standardizing processes and protocols for critical care settings, non-critical care settings, transitions, and perioperative situations. Embed guidance from your protocols into your order sets as much as possible while integrating these tools into the flow of patient care. Then, raise performance incrementally by moving up a hierarchy of increasing reliability.

  1. Designing reliability and other methods to ensure successful implementation.
  2. Building and Implementing the protocols /order sets and comprehensive educational programs.
  3. Hyperglycemia Hit Squads: A Special Intervention to Consider.

Continue to Improve:

Learn by testing and refining change in the clinical setting. Revise the protocols and order sets to embrace appropriate variation. Take steps to weed out inappropriate variation. Spread your improvements to other units.

  1. Learning in the clinical setting: Plan-Do-Study-Act.
  2. Spreading improvement to other units.
You will also have access to:

Why Should You Act? Click to expand

  • Hyperglycemia is associated with poor outcomes in a broad range of hospitalized patients, and several studies demonstrate improved outcomes with improved glycemic control.1
  • Hospitalization presents a frequently missed opportunity to diagnose diabetes, identify those at risk for diabetes, and to optimize the care of patients with diabetes via education and medical therapy.2, 4
  • Despite authoritative guidelines and effective methods to achieve good glycemic control safely, poor glycemic control, suboptimal medication regimens, incomplete patient education, and uneven communication with outpatient care providers are prevalent problems in medical centers.3,4

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Fundamental Principle for Glycemic Control

Insulin infusion or physiologic subcutaneous insulin regimens that are tailored to the patient's nutritional status and other factors are the best ways to control hyperglycemia in the hospital. The implementation of such regimens can only be safe and effective in improving glycemic control when achieved with a multidisciplinary team.

Glycemic Control Case Study:

Read about Sutter Health Network's, "Implementing New Order Sets and Advancing Glucose Control"

Glycemic Control Implementation Toolkit Project Team
This implementation toolkit is supported in part by a non-educational sponsorship from sanofi-aventis US, LLC

Disclaimer
The Glycemic Control Implementation Toolkit is an online resource for visitors to the Society of Hospital Medicine's website. All content and links have been reviewed by the Glycemic Control Implementation Toolkit Project Team, however the Society of Hospital Medicine does not exercise any editorial control over content associated with the external links that have been made available via this website.